If top surgery is the next step in your surgical transition, the question begins- what type of surgery is right for me? With over 15 years of experience in multiple techniques of transmasculine top surgery, Dr. Stiller knows each patient's journey and goals are different and is here to help you along the way. The size of your chest and elasticity of skin will play a major role in what surgical option is best for you. The most common deciding factor is ptosis, or sagging, of the breast. If there is any sagging breast tissue, a keyhole mastectomy is usually not the best option. During your consultation, Dr. Stiller will review the different methods of surgery available and make recommendations based on your anatomy and goals.  

Dr. Stiller encourages patients to look through before and after's or bring pictures themselves to make sure their goals are met.  

Although Dr. Stiller performs all surgical techniques for top surgery, a double incision mastectomy, with or without free nipple grafts, or a keyhole mastectomy are the most common surgical options he provides that give patients the most satisfying results for a more masculine chest.

A double-incision mastectomy is a good choice for any patient with breast ptosis. This means that breast tissue is falling over the inframammary fold of the chest and is sagging. Dr. Stiller begins the procedure with liposuction of the axilla (armpits) and lateral side of the chest. This allows him to contour the chest to create a more masculine shape. Incisions are then made to remove the extra breast skin and tissue. Most commonly, patients will opt for their two scars to follow the shape of the natural crease of the pectoral muscle giving the scar a curve however, you may also request a more horizontal incision. Patients with larger breasts or closely placed breasts most commonly will have a single incision across the chest. If nipples are desired, they are removed, resized, reshapen and then repositioned on the chest to a more masculine position.  

Recovery

The recovery for top surgery varies from patient to patient, however, most patients do very well. The procedure itself takes about 2 hours and you will leave the hospital that same day. After surgery, you will be placed in a chest compression garment, have dressings on your incisions as well as a drain placed on each side of the chest. Drain care will be reviewed before you leave the hospital. It is best to leave your compression garment on until your 1 week appointment.  

At the 1 week post-op appointment, your drains and nipple dressings (if you received nipples) will be removed. New bandages will be placed on the nipples which are to be kept on for 5 days. At the 5-day mark, you can remove them and continue with an antibiotic ointment and gauze. Gauze and antibiotic ointment will need to be placed on the nipples twice a day until they heal, most commonly around 6-8 weeks. You will wear your compression garment for 4 weeks total as long as there are no complications. Patients can usually begin light chest exercises around the 4-week mark but are encouraged not to lift arms above shoulders or any heavy lifting for 6 weeks.  

The Keyhole Mastectomy, also known as peri-areolar subcutaneous mastectomy, is ideal for patients with a smaller amount of breast tissue, usually A or small B cup, that do not have any ptosis. No excess skin is removed during this procedure so good elasticity of the skin is important to make sure the skin shrinks down to the chest. Dr. Stiller begins the procedure with liposuction of the axilla (armpits) and lateral side of the chest. This allows him to contour the chest to create a more masculine shape. The procedure consists of removal of breast tissue through a small incision around the nipple-areola complex, usually 1 inch in length. The nipple stays intact with the breast and are not repositioned or reshaped. If more masculine sized nipples are desired, this can be done at a later surgery to reduce risk of complications with nipples.  

Recovery  

The recovery for top surgery varies from patient to patient, however, most patients do very well. The procedure itself takes about 2 hours and you will leave the hospital that same day. After surgery, you will be placed in a chest compression garment, have dressings on incisions as well as a drain place on each side of the chest. Drain care will be reviewed before you leave the hospital. It is best to leave your compression garment on until your 1 week appointment.  

At the 1 week post-op appointment, your drains and dressings will be removed. You will wear your compression garment for 4 weeks total as long as there are no complications. Patients can usually begin light chest exercises around the 4-week mark but are encouraged not to lift arms above shoulders or any heavy lifting for 6 weeks.